Provider Demographics
NPI:1134565039
Name:HENSLIN, STEVEN D (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:HENSLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3936 SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-1506
Mailing Address - Country:US
Mailing Address - Phone:920-904-7499
Mailing Address - Fax:
Practice Address - Street 1:616 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3134
Practice Address - Country:US
Practice Address - Phone:920-921-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIW9205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist